Trans Fats, Big Brother, and Sloppy Science

Be afraid. There’s a plot to poison you with fat, trans fats to be precise or trans fatty acids to be even more exact. There are two articles in the Annals of Internal Medicine (here and here) which give a pretty good idea where medicine is heading. You’ve likely heard about trans fats. Their chemical structure is shown below compared to cis fats.

Structure of cis and trans fatty acids

Following Denmark’s lead New York City has made it illegal for restaurants to use the stuff in preparing food. The reason for banning trans fats is that doing so will convey a health benefit. No matter that no study has shown that doing so actually reduces the risk of heart attacks, what counts is that there is “no nutritional benefit” from this lipid. I guess a calorie doesn’t count. By this standard chocolate has no nutritional benefit. I’m not sure what epidemiologists and nutritionists mean when they talk this way, but they get a lot of attention by doing so. What they should be saying is that trans fat intake has effects on cholesterol metabolism that may be harmful. They’re not going to get a lot of press saying that and they’re also not going to get the law changed so they stretch the facts.

The first paper in the Annals says that trans fats “poses a substantial risk to heart health.” The next sentence concedes that there are no randomized controlled studies demonstrating that reducing dietary trans fat conveys a cardiac benefit. You’ll have a hard time finding that lowering cholesterol by itself conveys a benefit. The reason? It doesn’t. Let me explain. Lowering cholesterol is unquestionably beneficial in patients with other cardiac risks, eg hypertension, diabetes, family history, pre-existing heart disease, perhaps obesity. But if your cholesterol is high and you have no other risk factor for heart disease lowering cholesterol (so called primary prevention) has never been show to be beneficial. The authors of this first article who work for the New York City Department of Health are frustrated. They warned the public about the putative ill effects of trans fats, but the public didn’t listen. So the Department decided on coercion. “Because artificial trans fat is both harmful and fully replaceable, allowing continued use, even with disclosure, could not be justified.” These guardians of the public’s health are not impressed with their regulations being called “nanny state meddling.” They know what’s good for you and if you don’t like it eat in a different city.

The second paper is an editorial by the former director of the Centers for Disease Control. Another bureaucrat, she’s even more sure of the harm of trans fats than the New Yorkers. “The scientific rationale for eliminating exposure to artificial trans fatty acids is rock solid…..they are certainly harmful.” In the next paragraph she too concedes that this certainty “is still untested.” She means that lowering dietary trans fat intake has not yet been shown to reduce heart disease. Yet she wants everyone to stop eating it even if they are in a group that could not possibly benefit from dietary parsimony.

Would it surprise me if eliminating trans fats from New York’s or the nation’s or the world’s food supply had a beneficial effect? No. But it couldn’t be very large given all the other variables that cause heart disease. But the issue is not trans fats. It’s government deciding that educating the public is only worth while if the public listens. It’s unelected officials taking it on themselves to tell the unenlightened how they should behave. It’s enlightened force. It’s a harbinger of what’s to come as the government gets even more involved with medical care as it certainly will. Expect someone with a slippery grasp on both science and ethics to increasingly order you to live the way they think is best for you even if you disagree. Keeping the drinking water safe and eliminating infectious disease apparently are not enough for the folks in the Department of Health, they want watch over you at every step. Remember intentions and outcomes are synonymous.

So why zero in on something nebulous when well documented far worse items are out there…..sugar ladened sodas, candies, etc.???? Trans fat lobby too small???
“Expect someone with a slippery grasp on both science and ethics to increasingly order you to live the way they think is best for you”

No, best for THEM!! Any manufactured excuse to increase their bureaucracy. More will come regardless of science and ethics!!!

From a public health standard trans fats are small beans. I don’t really care much if they’re removed from the food supply. It’s the government telling us what to do over an issue that is not very important that bothers me. It’s the presumption, a certainty rather, that we should behave as they want and be forced to do so. Don’t worry, soda, candy, and a lot more are next. Soon we’ll be like Mel Brook’s 2000 year old man – subsisting on a diet of stars, clouds, and an occasional stuffed cabbage. Equally bothersome is when so-called experts misstate the science behind their assertions.

I agree with you but I’m more cynical because beneficial health items are prohibited as well.
For instance I’ve used stevia (stable above baking temperatures with no negatives…..and no calories) for decades. Its a weed I grow in my garden. Yet the FDA prohibits it in baked goods for no health reason.

Remember when Bush told New Yorkers after 9/11 to clean up asbestos laden debris with vacuum cleaners?? This after government field workers spent years developing a method to deal with this needle like crystal.

And remember thalidomide?? OK that, but attack vitamins & minerals.

And why did the RDAs become MDRs at much lower levels?

Now I have to look up this 2000 year old man you mention. Maybe we should put him in charge!!

[…] The FDA just banned trans fat. The American Heart Association issued a statement that the move would prevent 20,000 heart attacks a year mirroring that made by the CDC. Where this number came from is a mystery. I suspect they made it up after a series of extrapolations from metabolic data to epidemiological conclusions based on no epidemiological studies. Professional societies do this all the time. Will eliminating trans fats from a healthy person’s diet (note healthy) reduce his likelihood of a heart attack? While many of my colleagues express no doubt that it will, the correct answer is that no one knows because the data needed to justify such a conclusion haven’t been assembled. I’ve already written about this subject and you can read it here. […]

About Neil Kurtzman

Neil A Kurtzman MD is the Grover E Murray Professor Emeritus and University Distinguished Professor Emeritus, Department of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock. He has combined careers in clinical medicine, education, basic research, and administration for more than 30 years.